Ekiti State CDTI annual project technical report submitted to Technical Consultative Committee (TCC): May 2002 to April 2003

/ a IIfiTI $TAT[ CDTI /APOC PHOIfiCT ORICINAL: English COUNTRY/1.{OTF: Nigeria Proiect Name: EKITI STATE CDTI /APOC PROJECT Approval year: 1999 Laulching _year: 2000 Reportins Period (Month/Year): Moy 2002 - April 2003 Date Re-submitted: Jon u,ary 2004 NGDO partnerz UNICEF YEAR 3 ANNUAL PROJECT TECHNICAL REPORT Toj TECHNICAL CONSULTATIVE COMMITTEE (TCC) l,lStaziotr '-^," AFRICAN PROGRAMME FOR ONCHOCERCIASIS CONTROL (APOC) . .1, ,"*/ W/ l\, WIJOiAPOC. 2(r Septernber' 2003 ANNUAL PROJECT TECHNICAL REPORT TO TECHNICAL CONSULTATIVE COMMITTEE (TCC) ENDORSEMENT Please confirm you have read this report by signing in the appropriate space. OFFICERS to sign the report: country' NIGERIA/LIBERIA National Coordinator Name: Dr, Date: Zonal Oncho Coordinator Name: Mr. A.O. Jaiyeoba Signature: .. Date This report has been prepared by Narne : Rufus Oboweyo Designati on: State Coordinotor Signature /. Y. Jiya ;'-t=i:t-I'/rllr4'i,4 :1.1..-';..,.. .'I. . . ... Sign, Date i ll WI IO/APOC. 26 September 2003 Table of contents DEFINITIONS FOLLOW UP ON TCC RECOMMENDATIONS EXECUTIVE SUMMARY 3.1 . FtNnNclal coNTRrBUt-toNS oF t-rrE pAt{tNERS AND coMN4[]Nr-rrt-.s 3,2. OrHpR FoRMS oF coMMUNrry suppoRT 3.3. ExpeNorrunE pER ACTrvrry ............. SECTION 4: SUSTAINABILITY OF CDTI.. 4.1. INTcRNaL; TNDEIENDENT pARTrctpAloRy MoNrroRrNG; EvRLuarroN ......... 4.2. CowtvtuNtry sELIr-MoNrroRrNG nNo StRx.euoLDERS MEErrNc 4.3. SusrnlNnstLITy oF pRo.rECTS: PLAN AND sET TARGETS (MANDAToRv Ar yR 3). 4.4. INTEGRrrrroN................ 4.5 OpennrroNAr. REScARCH SECTION 5: STRENGTHS, WEAKNESSES AND CHALLENGES IV v .l .3 SECTION 1: BACKGROUND INFORMATION ......., I .l . GeNpnal TNFoRMATToN ....,........... L I .1. Desuiption of the project (briefly) I . 1.2. Partner,ship......... 1.2. Popur-RrroN euo HenLrH sysrEM SECTION 2: IMPLEMENTATION OF CDTI............ 2.1. Penloo oF ACTrvrrr8S............... ..........................g 2.2. ORDERING, sroRAGE AND DELIVERy oF IVERMECTIN.......... ............,......1 02.3. ADVocACy aNo SpNsrrrzATroN...... .................122.4. MoetLtzRnoN AND HEALTH EDUCATToN oF AT Rrsr( coMMUNrrrES..........................132.5. ConauuNIlES TNVoLVEMENT IN DECrstoN-MAKINc ............162.6. CrrpacrryBurlDrNc ....... . .......1g2.6.1. Training.. ...........,. lB2.6.2. Equipment and huruan resource,t.. .20 CoNotrtoN oF Tr-tE DeurptvtENT * PLgese srA'r-E ..........202.7. TRnnrnleNrs ................. ... ............222.7.1. Treatruentfigures............ .........22 2.7.3. Trend of treatment achievernentfrom CDTI project inception to the current lts6ly)/2.8. SupenvrsroN................ ............. ,...28 SECTION 3: SUPPORT TO CDTI .29 .29 .30 .30 31 3l 3t 1) JJ 34 ....34 lll WHO/APOC. 26 Septernber 2003 ,4 5 .6 .8 Acronyms APOC ATO ATrO CBO CDD CDTI CSM IEC LGA LOCT MDP MOH NCDO NGO NID NOCP NOTF NPHCDA NPI PHC REMO SAE SHM SOCT TCC TOT UNICEF UTG VHC wHo African Programnre for Onchocerciasis Control Annual Treatment Objective Annual Training Objective Community-Based Organ ization Commun ity-Directed Distributor Cornm un ity-D irected Treatm ent w ith Ivermecti n Community Self-Mon itori ng Information, Education & Communication Local Government Area Local Onchocerciasis Control Team Mectizan Donation Program Ministry of Health Non-Governmental Developnrent Organization Non-Governmental Organ ization National hnmunization Day National Onchocerciasis Control Programme National Onchocerciasis Task Force National Prirnary Health Care Development Agency National Programme on lmmunization Primary health care Rapid Epidemiological Mapping of Onchocerciasis Severe adverse event Stakeholders rneeting State Orrchocercias i s Control Tearn Technical Consultative Cotnmittee (APOC scientific advisory group) Trainer of trainers United Nations Children's Fund U ltirnate Treatment Goal Village Health Committee World Health Organization IV WI IO/APOC, 26 September 200J Definitions (i) Total population: the total population living in meso/hyper-endemic communities within the project area (based on REMO and census taking). (ii) Elieible population: calculated as 84Yo of the toral population in nreso/hyper- endemic conrmunities in the project area. (iii) Annual Treatrnent Objective: (ATO): the estimated number of persons living in meso/hyper-endemic areas that a CDTI project intends to treat with ivermectin in a given year. (iv) timate Treatment calculated as the ntaxirnum nuntber of people to be treated annually in nreso/hyper endenric areas within the project area, ultimately to be reached when the project has reached full geograplric coverage (normally the project should be expected to reach the UTG at the end of the 3'd year ofthe project). (v) Therapeutic coverage: number of people treated in a given year over the total population (this should be expressed as a percentage). (vi) Geographical coverage: number of communities treated in a given year over the total number of rreso/hyper-endenric comrnunities as identified by, REMO in the project area (this should be expressed as a percentage). WFIO/APOC, 26 September 2003 FOLLOW UP ON TGC REGOMMENDATIONS Using the table below. fill in the recommendations of the last TCC on the project and describe how they have been addressed. TCC session 17 Number of Recommendation in llte Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT U$E ONLY 2s8 The role of the village health comnrittees The VHCs, rvhere functional, perform the following functions: programme implementation at cornmurrity level at comntunity level '). Assess, identify problerns & proffer solutions 't Specifically on CDTI. they send information where shortages of Mectizan occur. give supporl to CDDs, eff'ect CDD changes rvhen needed. and shares reactions (positive & negative) rvith health personnel Without the VHCs involvement no health programme is successfully, carried out. 259 The terminology 'ATO' and 'target population' are used interchangeably. and no UTG is given. The total population in the endemic areas is not mentioned. The ATO and total popLrlation are given in tables 8 & 10. The project is yet to determine the UTC because the total population figures need updating. A cornprehensive census update is planned for last two weelcs of February 2004, with funds from UNICEF. Thereafter a realistic total popLrlation rvill be kno'u',,n and the UTG deterrnined. 259 The nunrber of CDDs is still very low (631 :l ) and TCC recorlmends an increase of CDDs The training data on the report is erroneous. They are actually an update of Year 2 training data. The Year 3 training was carried out after the distribution drre to Lrnavailabilitl, of firnds. 2,518 CDDs were trained bringing ratio to -100:l . The project will continue to encollrage communities to select more CDDs. 260 Total population should be stated and the therapeutic coverage calculated for the past 3 years based on the These have been addressed in the report. See tables 8 & 10. TCC is invited to note that a rnajor census Lrpdate is being schedLrled for WI'lO/APOC. 26 September 2003 total population instead of ATO. Further, all the indicators stated in TCCl4 should be given in the report. February 2004 t TCC session 15 TCC session 13 Nr4mber of Recommendotion in lhe Report TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT USE ONLY 80 Clarification on 8% decrease in treatments provided in 2000. At the end of 2000 treatments stood at 498,127 over the 330,81 8 persons treated in 1999. 80 Clarification on the UTG ofthe project Already addressed 80 Project should reach full geographical coverage Efforts are being made to achieve firll geographic coverage by the 4th year. Reasons for not reaching full coverage are highlighted in the report. 80 More CDDs to be trained in 2003 2,518 CDDs were trained /retrained in 2003. Communities are being encouraged to select more CDDs, but they are reluctant on account of incentives to be given Nuhtber of Relommendotion in lhe Reporl TCC RECOMMENDATIONS ACTIONS TAKEN BY THE PROJECT FOR TCC/ APOC MGT USE ONLY 38 Clarification on ATOs for the upcoming years as ATOs given in the original APOC proposal for years 3 - 5 exceeded total population given in this report The figures given in the Appendix I of the proposal were estimated total populations to be covered. We have seen about a 9o/o increase in the total population for Year 3. A better and more realistic figure will be obtained after the census update 38 Clarification on the total population ofthe 416 endenric communities (is it 625.303 or is this figure the ATO for 2001 ) See treatment over the years, table l0 38 Cost per treatment not estimated Orr funds released by all partners, cost per treatment stood at $0.25 38 LGA staff needs rnore sensitization to ensure good reporting and involvement This is being done, and the project intends to bring more health workers into the programme. This will reduce the burden on LOCT leaders, who are programme officers for NPI. (Plea.se more roYt,s iJ nece.ssctrl') ) WHO/APOC, 26 Septernber 2003 Executive Summary Prepare un Executive summary of the report in not ntore lhun one page . El<iti State, located in the soLrth western part of Nigeria, u,as carved oLrt by presidential fiat from Ondo State on October 1996.itcovers an area of approxirnately 5,500 square kilorneters It has a bioclimate of rain forest in the southern area and Guinea Savannah in ihe northern parts. The Yorubas constitute overwhelmingly the major ethnic group in the State and it is mainly the indigenous population. With acurrent projected population of about2.9 rnillion the State is divided into l6 LGAs. Population movements occur in rligration from rural to urban areas in search of better Iivelihood or temporary relocation to farm areas during the cultivation and harvesting seasons There are344 communities that are endemic for onchocerciasis and the target population is 1,006,019 persons. Within the reporting period a total of 741.596 personr rrer. tieated representing a74oh therapeutic coverage ivhile 334 communities were covered. The latter represented a 91%o geographic coverage. A total of 2518 CDDs rvere trained during this third year of project implementation representing 75oh achievement of the training objective of 3,360 persons. A l0o% achievement was recorded with regards to training of health rvorkers rvith the training of 608 persons. All the State Onchocerciasis Control Team metnbers were trained specifically on record keeping, reporl writing and effective use of monitoring and supervising checl<list. The constraints/challenges facing the project include: supply of vital and urgent inforrnation as demanded by'the NOTF secretariat. rates. J WI-lO/APOC. 26 Septernber. 2003 t SEGTION {: Background information 1.1. General information I.l.l. Description ofthe project (briefly) Geographical location, topography, climate Ekiti State, located in the south western part of Nigeria, rvas carved out by presidential fiat fronr Ondo State on October 1996. it covers an areaof approximately 5,5bd square kilorneterq It has a bioclirnate of rain forest in the southern area and Guinea Savannah in ihe northern parts' A greater percentage of the landrnass is made up of rocks and nrountainous regions. ThJ rains commence in April and ends in October, rvhile the dry seasons starts from October ending till March. Pop ulatio n : act ivit ies, cu ltures, I ang uage The Yortrbas constitute overwhehringly the rnajor ethnic grolrp in the State and it is mainly the indigenous population. However, individuals from otheiethnic groLrps such as the Fulanis. Igbiras, Agatus, Igbos and Hausas have migrated into the State una ui. cohabiting with the indigenes. With a cLlrrent projected population of about 2.9 ntillion the State is di-videa intol6 LGAs. Settlernent pattern is compact with population densities of between 2g0 - 350 persons/square kilometer. Farmsteads exist but they are seasonal. Communication system (road...) Roads between major cities are in good condition, but access roads to most of the endemic communities are in poor shape. Some are not passable during the rainy season. Despite this transport by road remains a major means of comrnunication arnong the communities. The electronic and print media are also veritable channels of communication. Within the communities the town criers and announcements in churches/mosques are preferred means of communication. A dmi nist rat io n s tr uct ure The State is made up of l6 administrative units l<nown as local government areas. Each LGA is headed by a Chairman, usually elected. who is assisted by carier officers. There is a legislative arm made up of elected councilors fi'orn the various rvards that nral<e up each LGA. Beneath the ward level are the communities. At the State level. the Governor is tlre chief executive, and he is assisted by an executive council rnade up of cornmissioners rn charge of various ministries. There is a legislative anr conrprising elected persons fiorn the LCAs. Health syslem & healtlt core delivery (provicle the number of heatth posts/centers in the project area if the information is available). There is an official PHC policy and structure in the project area.lt is a system of health care services where conrnrunity parlicipatiorr forms the nrainstay rvith supporl fronr the State. Local Government and NGOs. Levels of firnctionality horvever var),across the State. Scattered throughoutthe State are various health facilities ranging fiorn health posts to hospitals. There are 552 health facilities in the project area. I \,\'FIO/,APOC. 26 Septernber 2003 1.1.2. Partnership Indicate the partners involved in project implementation at all levels (MoH, NGDOs - nat io n al, i nter n ot io na l) The partners involved in project implementation within the project area are UNICEF/Nigeria, NOCP (National & the B - Zonal offices), the State Government, the various Local Governments and the endemic communities. Describe overall working relationship among partners, cleorly incticating specific oreas of project activities (planning, supervision, odvocacy, planning, mobitization, etc) where all psrtners are involved. The State and LGAs through their various units are involved in training of field personnel, community mobilization & health education, management of side reactions, planning and managernent of project implementation, supervision and monitoring, and Mectizan procurement and delivery. UNICEF is involved in supervisory, advocacy and training roles and assists in logistics provision. The Zonal and national offices assist in supervision, monitoring, training, advocacy, Mectizan procurement and evaluation of the programme. The communities paly such roles as selection and remuneration of CDDs, collection of Mectizan, determination of mode and period of drug distribution, census update, Mectizan distribution and recording and reporting of treatrnents. Stale plans rf any to moltilize the state/region/district/LGA decision-mokers, NGDOs, NGOs, CBOs, to ussisl in CDTI implententation. lA nationwide election into positions in the LGA will take place by early 2004. New policy imakers will be enlightened and rnobilized to sr,rpport CDTi activities. lWithin the reporting period Drivers' Union and Market Women Associations were mobilized and efforts will be made to re - rnobilize them. The project also used the monthly meetings of Oloris (the wives of the traditional rulers) to mobilize them for CDTI. This will continue in order to get thern fLrlly involved. A CBO with the Olori of Ewi as President will be mobilized as well as an environmental based NGO which approached UNDP for funds to support CDTI. The project additionally intends to approach Island Club and Rotary International (State Chapter) to get their assistance for CDTI. 5 WHO/APOC. 26 September 2003 Ff.= :,: =:!v)L ro -oo .= laN !\ Ei r€ 9Ftr- >.! o o *dE9 N= E:U :! Etr.=: OYL -Lro-2 oo co c.i o. OO f- =j- O \o\o @ d aa ca\o O ca @ \o oo oo oo^ O <l (\ \o !+!+ @ \c) t-- Ot-- O a\ t-- O 00 \c) O co oo c.} $(.l a.lO ,] c..l $ @ oo co tr- 00 .{ c'.1 I $ aa o. \o \o $ O O a.) o\ O co oo\o O F-$ (..1 <-1 c\ C' @$ d r- --:. =f $O\O tr- <l O$ n@\o c\ co O O a- \o\o(\ (o !j'$ aa O O IL dN (U F ;c- {,E E otr >1 o N EgE i-a YoU 3xL2 (] Z \o O c'l @ a.l .-.l O CI r- ta) al <l O a\ N O \o +N O c\l \o a.l N co C\ +N N caC\ O (\ co o, I o, C!tr9 9Ya e i3 er.lX *e,9' ,v9F!rA-^ @ o. @ cio O r- -.r O \o O O. \o O ooco?O 'f, O c.l \o .1. =f @\o O t-- OOO. Or- O C\ O 00\o O q.Q)a .lePo -E'; d?!< g.s bJ E (-) .vr! -o ,a trl CIq =Jt! > o U) 't t! o .= :l Lr-l 't, o -o(, () Et! ,a o o L6' () L OJ o 0) g o :l () 'd 6g o .0) o o- o) ca N o -o E OJ o-oa N U o o p ^: q) h F; F*! -.: .9 L()o bo .'; L o o-(J L o oo e L tf o L o 'o O (J L OL O L() (.) E (, a(, o ql og -a L o (s o- o o- _:-ur. 6! -aqC,)aJ .; qr =\\ -q .- )J -l I0t --ol €lFI E o +J o o a I I tu o J. E q tr o +, fit)c or N a F \o cl o E C) o- c)a N l) o oo\.=s'a bUPil\ -iq.q *A'-O!Lga.? iqr6 s\=S\Os s f ,; -{ } ea -\-vr q, =or-vEVSi \ 9c.rd s Ex; s cf -* s -9b\\ =O\' i d=E - ol Ei.{(- .I;l'Sor\i x t\! u 9 LV ci- \ \: O'r,i\ E' V 505is i i '3v$b t i 9'-ia t : y,3OVA--= ^S=o * .E' E3 . :" H S o >'Es i i := ;:' d S A dS\ c- : ! =SU .2 ir u!:s = s :us--C6it F N #EiP *, .E q:G) .= E - csiE E S Y=i.{-qv cs + lJ -.tsL. (J = \ .= -tr,Ei .e S €E ^-'-PS-6l>- -r! .\ii U R ;EI( x t' -eSe U " oo as tr i $ ljo = is U = i=t' i:i = a -.C.= t-3; e \ ;E f,J=iuC\rf,F\ -tr.Y O .t' c - S'ts9' '5 = =6 EdF (! s 9E E -qs = s 'E6 ro-) e S = Q e:S a- P L (s SiE n I s., {. =i t o50 s' =oE\tr(g\t6Jq.)L9\ s! i \ c.= aip^ € u od 'SE+ = S P-C tr '= i o \j a- sFi E YN *E E -pJ I 3tr E= P;: : ;! e+ 'ISil O i-qr (Jn SSi'= :t .r? i;-EE = b= =p t,:\, U F -ll $Ctr,of >, ' i 5F\St--orP tr (o Q "t =lElol el Idl cl .9 I 6lzl I =c! ^q r- Oo o" \o c,) o\ tf,\o o\ \o N a-'lC\ \o\oq * c.l fa 6l6l .a l'-\or- c.i$ r- NC\ o\(.) o\ rr (-) @\o c.l(-.l NN !+ tf, ?o \o € t-- \o lrl\o(\ o \o ca o. +\o o\ \oo (6 -o o J F F SEGTION 2: lmplementation of GDTI 2.1. Period of activities Inserl Plan of action indicating activities bl,rnonth. which rvere implernented 8 \ /llO/,APOC. 26 September 2003 N Lq) -o E 0) o-() U) \oN O r L,, > (h(n o0 .E .E L ,o o -.:t6 'O oloc LA th g, EtA GtgB 9- a9 oo -:" 9.3 ()(, .oE i4 oo9tri'. JC)oc dA !lt(!* FU; cr).=():- E>. bO.= ^!trcd -c3 -o6 E.Y .9e de <) tt) -(BsB ,a q(- fto .= o-o 0)!- L6!E '9 ar tro e a0) O0 q- oo?CU CU .;() F(!It c) (r') C) E oU I o, *oEE (,) J o- I o- J o- J =o- J d. I J l J J d. J r J r J r J q J U) o o !o :d C.l 2 2 o EE ) d, q(ll l! f, c0 tL l t!lL /. l d. cc[! tL 3 c0 L!t! f tD TL d f, t! d.) ull! L!IL /,) a rl] d) a r! )d a iJ.,l I& -)d. a f.l,l tL :l r!L 3d ulf! f,d c0 tJ.)l!o od ^l UDEE FC u)- F U))(,) Fa)(, f F(n f, Of, Faf, Of, F CN3 of, Faf O) F U)f,(, f, Faf, Of, F(t)(,) F(t f,(,) Faf, of, Fa) Of Fa)(, 3 F(h O) Fa) o) F U)f, ol *o trE U ) II d. f, 4 IL d) d, tLltr a trl lJ- f, t! ll. U tL ) IL /. !q.l t! d. g a lL d f, co r!E f d, q Il.1f! f,d o.l u. f/, car! d, ) cat!lr d, tr c0 r!tl f, r IJl IJ. .x q) (t) o 4) U bntrE a- Fa) of, Faf o) F(nf, O Fa :l o :) Faf, of, Faf,(, f, Fa tr Of, Faf,()) Fa) Of, Faf, of, Fa)) Fa) of, Fa D(,3 Faf,(,) Fa :) O) F C')f,(,3 o.EEE(, l Jf, ) J) Jl l If Jf I = J3 J) JD J) J) Jf J)-xo( F a0 t! z tJ] zl o.l z) Lllzf, t!Z t!Zf, tlJZf, ulZf, ti Zf, r! Z) ir) zf, !l Zf, tD z) tLlZf, U zf, rll 7 :) o =trEE U Jf Jf Jf, I) J:) J = j f ) J Jf, J) Jf, J) JD Jf, Jf,.= .i5iE €= li q)a boEE a- 2 2 Fl I 4) E Vt! o Z olL r! Fa :EFf, o(r) EV trl Fa Ld E ut! i! f !l Z Z o O a o o o tll u.)u r!J c Y zf, d, o GIq q r! ql J Z) o oJ!l(L z) ! q tIJ o t! ,l l'r F l) q l P p o 1r .E q) ! qJ oLL O 0,) '10g ct o+ ,l () C) .o ,h 6_) o (, o F ojt 2.2, Ordering, storage and delivery of ivermectin Mectizan@ ordered/applied for by - Qttease tick the appropriore answer)MoH/NoCp./tr wHotr uxlCrr.I NGDOtr Other (please specify) Mectizan@ delivered by - (please rick the appropriate unswer)MoH{] wHotr UNICEFtr NGDOtr Other (please specifo) Please describe how Mectizan@ is orclerecl ancl how it gets to the conununities The quantity of Meclizan@ required by the project is calculated based on treatments and totalpopulation from the last cycle. NOCP processes the data after receiving inforrration from other UNICEF - assisted States and submits re - application to rhe MDp. On approval the drugs are shipped to the country and UNICEF facilitates clearance and storage. th. Stut. or. the Zonal office picks up its consignment fronr NOCP and releases to the LGAs through the LOCTs' LOCTs release drugs to the district health supervisors or the health facility staffwho in turn make them available to the comrnunities. FLOW CHART OF MECTIZAN DBLIVERY Reporting flow UNICEF/ Nigeria Delivery process MDP NOCP Zonal Office STATE LGA District Health Facilities Communnities r0 WHO/APOC, 26 Septernber 2003 Table 3: Mectizan@ Inventory (prea.se aclcr rnore row.s if necessary) Stute activitiOs untler iyermeclin deliverl, tltil are being carried out by healfh care personnel in lhe project oreo. The health persoflnel at the various levels have been responsible for the following '/ Supervision of CDDs. Any other corliments StateiDistrict/ IrGA Number of Mectizan tablets uested Received Used Lost Waste ired{do Ekiti 150,030 150,030 149.999 3l lton 105,000 I05,000 105,000 Ekiti East 180,000 t7 5,040 174,998 42 Ekiti South W 140.020 140,020 I40.000 20 Ekiti West 120.000 117.520 117.498 22 Enr ure 60,000 52.500 42.703 9797 Cbonyin 150,000 140.0 I 5 139,996 t9 Ido/Osi -T r60.000 150,005 139.996 12 Ijero r80,000 I57.930 I 57.905 25 Ikere r 60.000 157.530 144.991 32 I(ole I05.0 r0 t05.010 t04,989 Ise/Orun - 160,000 160,000 1s9,998 2 llejemeie 100,000 87.500 87,494 6 lrepodun Ifelodun I 10,000 r 05000 105.000 Moba 160,000 I 60.010 159.998 t6 o!e 150,000 140.020 139"978 22 TOTAL 2190060 2112677 2109,96 2 260 9297 ll WFIO/APOC. 26 Septernber 2003 2.3. Advocacy and Sensitization Slate the number of policyktecisiott makers mobitized at eaclt relevanr level rluring the curuent year; the reasons for the sensitiztrtion onrl outcome. Describe dfficulties/constraints being foced and suggestions on how ro improve advocacy. At the State level, the then State Executive Council made Lrp of Governor. his deputy, all 8 commissioners; the Permanent Secretary, Ministry of Health; Chairlren of'Local Covernment Service Council, State Teaching Service CoLrncil & Electricity Board as well as the Secretaryof the State Primary Education Board attended the workshop organized by the project to marl< the 2003 National Onchocerciasis day at State level. Also present at the occasion was the State Conrmissioner of Police & bomptroller of Prisons. The wife of the Governor sent her protocol officer to apologise foi trer inability to attend the workshop. The Deputl,to the Governor stayed till the end of the programme. At the LGA level several officers/policy makers were rnobilized during workshops and visits to the various LGAs. See table belorv. These were rnobilir.Jto support CDTI particularly in financial terms. After the various advocacy activities the Covernor approved the sum of one million naira each for CDTI activities and extraction of cataracts. But before the cheques could be processed the executive was swept away in the general elections and a new party forrned the present executive governor, and new LCA chairmen w'ere appointed. Static treatments commenced in sorne police barraclis and the prisons in the State capital. The rnajor constraint in achieving required objectives u,as the change in administration shortly after the rnajor political players were rnobilized. LCA TRADITIONAL RULERS OPINION LEADERS RELIGIOUS LEADERS MARKET WOMEN ASSOCs. OTHER CBOs Ado Ekiti J l0 J 8 5 Efon -) 7 I r0 I Ekiti East 2 t4 5 8 4 Ekiti s.w 3 6 4 4 I Ekiti West 5 t4 4 8 Emure J 5 6 4 I Gbonyin I t0 7 5 I Ido/Osi I 8 4 5 Ijero 7 l8 5 8 I Ikere I I5 I l0 2 Ikole 7 t8 ) J I Ise/Orun 4 7 I 5 aJ Ilejemeje 2 l0 1J l3 I Irepod/lfelodun 4 12 2 8 2 Moba 4 l5 1 8 2 oye 2 t2 J ) I Total 52 l8l 55 109 26 12 Wl-lO/APOC. 26 Septernber 2003 There is need for high level advocacy visits. The burden of onchocerciasis need to bekept 0n the front burner for the politicians through: LGA level ?.4-.,{g!ilir"tion and hearth education of at risk communitiesrrovtoe lnlormatlon on : !e- use of nteclia ,and/or other local sysrems to crisseminote information lnt project ntade trse of the following media for the mobilization of the endemiccommunrtles:(l) (2) Production and airing ofjingles as well health talks on onchocerciasis through the electronic media - Ekiti radio and television. Production and distribution of thousands of IEC materials, particularly posters to the endenlic communities. Comrrhunity leaders. Town criers - this is the principal nreans of information dissemination at the nity level (3) (!) (6) (7) (5) Heal LGAs education meetings rvith community rnembers by health personnel from the or CDDs. Vans Cultu fiilfilled most some incenti th mounted public address systems displaysilocal drarna on Mectizan treatment !(:!,!:::,:1l,rtrt.tr1,otrrt .educotion of women and minorities - methocr ancr response*'ll1l the prqJect, there is an active participation of female members of the community at m^obilization rheetings. and during health education sessions. In nrost cases at least two thirds of those preseht at a session are women. and they talk. Sorne of the women have volunteered as CDDs when those serving expressed unwillingness to continue due to lack of incentives. Sbme women had also had cause to meet the comrnunity leaders over remuneration of CDDs t'1hile some g4ve out money frorn their personal funds to support CDDs. In one particular instance the wonren rnet with a comrrunity - based club to aisist the CDDs, and' they have resolved to be meeting with different clLrbs each year to give incentives to the CDDs. There are no problerns with rninorities. Rgsponse o/' communities/villoges Cbmrnurrities ave responded by corning forth to collect their Mectizan tablets. Members willingness to comply with Mectizan treatment. The communities have f their responsibilities under cDTI sLrch as selection of their cDDs, giving to some of them and determination of the rnode of distribution. Irave ex Accomplis its co n an lncrease in awareness of the communities of the benefit of Mectizan, and Lual intahe over a long period of tirne. ent of r-nore cBos in the implementation process over what was obtained in the pa 'r There is an increase in awareness of the roles of partners/cornmunities in CDTI. is available. l3 WllO/APOC, 26 Septernber 2003 ll/ e a k n e s s e s /C o n s t r a i n t s commitment and non - invorvement oflearth faciritl,staff. the community is being denied its fair share. suggest ways to improve mobilizariott of the torget comnturtities. (l) Equipping Local NGos. Market women. Religious leaders, Road rransporr worl<ers and other community based organizatiorr with n...irory mobilization skills ivill h.lp;;;;;'.deal in improving mobilization of the cornmunities.(2) There should be regular rneeting rvith the conrrnunity readers.(3) The project intends to collaborate with relevant sections of the Ministry of Inforrnation/Culture in order to make use of appropriate staff rvith skills in community mobilization. t4 WtlO,/APOC. 26 Seprernber 2003 6l Lo -o E() o. 0) a \o a{ Q o q B t11 o\ a- a.l o\ \o O \o o.l o\O o\O \oO(\ \o + o\ \o \o t-- ca o\ o\ F-\o o\tr) \o 6\ .+ \o o\\o sf, I s o\$ v: -A. Ell3 r,o= o2 ad ;!trC;E :.J st 9d trdr 2+ I o oIl oo o oo oo ON O co 00 00 N t-- tr- ot O$ N (..lc\ O@c- \o r-- o\ ca oo .+ 6 ta(\l N O \o oo a.l a.t O .f, t- a- l_l6l- \o NO oo N O c-J 00 N co00 N a.) \ov(\l o z F + lt 2a =^a.l J 2l) @ \o 00@ oo00 O@ C-.lO c.l O ca o\ 6l 00N Nr- C\ \o \o o.l a.t co FIr-6l at o ot) U o\O o\O \o 6\(..l c- \o O = o\ O o\O -t \o $ \ao\ tr-\o \o r-\o \o F- c! \oo\ o\o\o o\ c* o\ o. o\ oo\o s w \o t-- 00 ca O o\ c\l O oo c!o\ Oc.l 6 (\l -? ea cX )o .gs .-LEq trs L. EE 7.4 l =z,Ae R E5 ' 'Fctro Zvza = E Io d o- o .: o o o s L 6 o O O a.l 00 a1 o.1 I (..l Oan c! c.lan Nal !f, =f.) o\O + o\ a.t =f, \o $ \o c.t t1- \o O o\Ns .o o\ .+ o\ :f .o .\ arf, €c ='-oy : vb E.= e za o bl) o LU d' ll * cocD N o\ v-1 al\o a.l ol o\ C\ \o O al at \o U? N\o t- N c.l N c.l N c.l sf N N N ot a L Z. c0 -Eo u! o' -G L r 6 O-C, L=r\' €:it .FD -= O O .i- =f, O O$ \o \o \o $O tr) a(-)6 L Jt! € r! tLl U oa .= :l rrl 0) .= :l 0.J E u 't o -oc o o L() "= () 0.) -V o o -Y L o C) .() oo C)r (n -o o >\ ol J F F 4 o N F IJ Q 0) ,= o o .: E E oU E) ,sJ G EI E 0 a- ,9(, ot tr r- J d ofi 0i o ,s o ,9 =tr J E E o u a U) c{' F 00 ai N a.l \n o\ aa\o Comment on: - Attendance of female members of the community at health eclucatiort meetings This has already been discussed This has already been discussed - Other issues In general, how do you rate the participation oJ'female mentbers of the conmtunity meetings when CDTI issues are heing discusses (attentlance, porlicipation in the discussion etc). t6 WHO/,APOC. 26 September 2003 2.6. Gap{city buitding 2.6.1. Training The project personnel at various levels conducted informal trainings shortly before drug distribution cgmme.nced, but the formal training sessions organized by the iroject was carried out atter the drug distribution. This was due to unavailability of funds. The'results of the forrnal trainin$ sessions are presented on the accompanying table. 4t WHO/APOC, 26 September 2003 c.l 0,) -o Eo o.oO N O o -) J aT lbo o u e -a € q L a) p 4 ^ts B o b. \ { p s U :t p\ o sts ts : .F U, ,) U! eJ = r- qJ\ o -: aJ u) qJ o_ ! o 0) tr() o- E t- ! U(ts a OJ () L ,0)iE rc (.)s bo C ,= LF ,;l orl -l F] N \o \o O C. co c..l oo aa o.l \o clF- v c\ O c{ t-- co \o N t-N \o : .f ON aa C...lO : (..l $ \o oo N oo CO C\l : _= O co O oo oo f (..l N o O(--. N oo oN ONi ao O O ca \o(-r :. \o 1 oo O ol o\ : oo .t :. 1 oo v^) r c{ oo : N .d- o C) o) a s 1r) r-. N (r) N Otr) O N aaao (a r- dll \, o,- +LV: .Q U U q = ?_ U LF O 0) gsF q)' oq) .q/ C'L z :. ca -] I .a t-- :l t-- a- :" ca -l I : rr : '.ll r- (-- r- C' I-r aa tr-. ca t- I aa (-- :: r-. aa r- : co .f, o..t =l e a'0 eo) CJ N C..t c.] cO N ",,o:",- 9q F 0) ql "i\t ol qJ I qJ ql z r.l c.l N : _] :l C\ c\ __-l ca : a.iN ca : c.l ca I a.t otl C' r/) : C.lN ."1 N a\ : co N c\ : aa I c.lN aa lr^i :' ..lI aa iK (-I N N c! : ca c.l N a\ C. r) a! NI cn N a.l 1 aa .i- (-..t ca -]*l o o' o.) e0) q) N ra) N N o] v^)a.l L/')N c..l v')N N a.t c.n N r7^)c.l c.l tr)N $ ?tr I d U (.) a< 32: F J o ltl z aa aa ca ca aa : ca I aa CO ca I : .a aa I ca I ca aa aaca CO co :l ca : aa I : aa I aa oo <f, co$ I co$ -l LtJ 'o J € trl J (g r! :E -v,r! I oU) ! Lr-.] q() J(J rrl J (, J() L trr! J 't o -o(, -.1 ,6 o o I J oL1(rl .--l cJ L q.) -v, J o oJ OJ L oq (, J 0) C) o C) D .d) \J -.] -oo oJ (_) \Ji I j F F o q) q) I -o ^\ ca I caaaaa caca aa t- t-- $ O ca (,Fv q q) q (J z Trainees Type of training CDps Other Cornmunity menrbers e.g Comrnunity supervi sors Health Workers (frontl ine health faci I ities) MOH staff or Other Political Leaders Others (specify) Program management How to conduct Health education ^/ ^/ { Management of SAEs CSM SHM Data collection Data analysis Report writing Others (speci fy) Table 6: Type of trlaining undertal<en(fick the boxe.s where specific t'raining v'as curried out during the reporting perioi) - Any othgr comments 2.6,2, Equipment and human resources Table 7: Status of fQuiRmen t (Plea,se adtl more row;t if necessary,) *Condition of the e ipment (FLrnctional, Currently non-functional but repairable, written off) )g APOC MOH DISTRICT/ LGA NCDO Others Type of equiprnent Source Condition of the equipment * Please state l. Vehicle I (functional) I (non functional) 2. Motor cycle I 6(functional) l5x'F 3. Computers I (functional) 4. Printers I (functional) 5. Fax Machines 6. Others I a) Bicycles 50(functional) b) TV set I(functional) c) Video set I (functional) ** 8 motorcycles ritten off WFIOiAPOC. 26 September 2003 1 How does the proiecr intund to ntainloin and replace existirtg equipment and orh'br materials? In the interirn the project rvill repair and maintain all capital equiprnents rvith the fun{s provided by APOC, supplenrented by the little got from the State and Local Covernments. Efforts will be intensified to convince government to release counterpaft funds for maintenance of project equipment and purchase of various materials. The project intends to request APoc to provide a replacement of most of the equiprnent supplied. - Describe the adequacy of availabte knowletlgeable munpower ut all levels. There is enough available manpower for CDTI irnplementation. The project however needs to train more health facility staff and ensure CDTI is part of their routine responsibilities. - Wherefrequent transfers of troined stoff occur, state what project is cloing or intenls to do to remedy the situotion (The rnost important i,ssue is what measlres were laken to ensure adequate CDTI implementation where not enortgh knowledgeable manpower was available or staff often transferred during the course of the campaign). Staff are usually stable. However, there are plans to train more health facility staff so that the area of coverage will be reduced and supervision enhanced. "l'O WI-lO/APOC. 26 Septernber 2003 2.7. Tre4tments 2.7.1. Treatment figures )- 4 wHo/APoc, 26 September 2oo3 N Lo -o E OJ o.o a al Q L.,) o- > o.l "n a -iJU\) S ? 6 s. \ .: CJ % t, e_ :l o .E (d U) OJ =d ; \JJ .I >, -o C) r! a E (g 0.) E O LF # I(Ji -olcl -l GY 9( o= 6-ra-,ao v-o = o2 a I ois !,Y. 6ap) o o a E z I I I I I I I I I I &L AC ^ rrl = u4 zu6 I I I I I I I I I I LOOQ -o ca co ..l O aa I O(-- r) co t.-o\ oo (n ON o\ F.[n 7,q=x c^; u =+ A Y i, u a! Urh-r! I I I I I I I II I =O'9 b! o-;L T o.^ EFU z cu == n)- 49s'r -tro L " ^-u = o *c O €E<': F-!= ; t?v u o \o C. .o o\ t-- 6\NA \o F- o\ v .o o\ <- \oo\N t-- \o t-- t-- \eo\$A o\ r- \o N o\N oo o\ $ .o o\ @ \oo\ t-- o\ t- st rr \o\o o] oo ca t'-- F ca NNO\o $r- r-- <f, oo (..l oo oo ca t--$ ca c.l N \o ca oo oN\o rr) oo (..l t-- ca O o\ aa cav o\(r) \o ao .+ t-- aa <f, lr) \o o\ tf.) trr O \o \o (-.l + (r)\o N OOtr) O <f, O aa O \otr) aa(r) O\o OO r- OO sf, O \o O ao o r o{ aa rr) O V') oo aa @ co\o tr) co ooN O t-- .f, o \o\o aav o, oo oo co tf, N rl.')\o $ .f, oo t-- O t- N F- oo\o O(r) C. lr)\o O C. o\ $ o\ \o =9o E OIJ 5rr:- u = y-uv a = ,- 9) 2ad u o \o :.U€ b E ', r ! *G E = 3<: = tr bo!? ceEd9to v20 Co E G 9F o = = ='a a 0) E tr tr o(, o\ \oo\ \oo\ OO \oo\O O \ao\ OO \oo\O \o OO o\OO \o \oo\ o\ o\ -oo\ O -o o\ a .o o\ t-- \o O sr- o\ ca O ol N ..l c\l N .a c-) N a.nON c.lN t+ c.)(.) O c.l N C...t (.N N OC. Oaa at a..l atN slr) ?o ca c'l N ON I N N co oao N c'.1NcoN cl(\ rf,!+(-) av (, J .o t! 'n- '.p, rl.] T' a a '15 -v,t! oI q tll ! tL) I (, J 6(J B i7 tLl (, J C) L E q () J ';. o -o J o L(.) a'1 J ,6 c op (, -.1 oL a) I IJ l2 o! (, J c (,) 6 O -]u 'd 6g (,J -oo ! o e 'o o o.o L J o c l] 3 F I I I ; €t col sl I{the projelt is not achieving 100% geographical coverage an(l minimum of 6s% therapeuticll coveroge rote or coverage rote is fluctuating, slote reasont oi4 pton, being made to remedy this. The principal rehson whycoverage had not been acceptable is unavailability of Mectizap This is coupled with inappropriate information on target populations provided by health workers from which project tries to determine its ATO. Effective coverage has also been hampered because of sporadic release of funds rnaking implementation of planned activities difficult. The project is additionally faced with the problem of inadequate mobilization of porntnunities by health staff due to problems of counterpart funding frorn LGAs. The proj$ct personnel has not been overtirne well able to supervise dLre to funds constraints. 2,7.2 llhat are thl muses of absenteeism? The major issue has to do with ineffective or lack of rnobilization of community members. As such when are supposed to be on - going some of the members rnight have gone for their farm work trading places. Unfortunately these absentees are not followed later 2.7.3. Briefly all known ancl verified serious adverse events (SAE| ontl provicle in table 9 the uired informatio n w lt en avail able. The project is unaw{re of any case of serious adverse event. 2.7.4. In case the proiect has no case of serious adverse event (SAE) during this reporting period, please tick in the box. No case to repoft 1r ,r-) wtlO/APOC. l0 April 2003 ca N L C) -o E() o.o U) \o o.l (J o o- o + ,J$i 0O c\U: U ! \\ 0a CO \ YU J\ vq o\!\d! O\\ c\OqJU o *='e: r! ,;s OU\ oi-a :90 U tE.S 9\r o\l g-9L x=t -: () F \: - '= \, ':\ r ! .I: \E{ -o \ .iuo l'\ <s -\sc: ! -r- ^,aJ v -s, =l 5 r 3: -l ,, E U : xl -o s i=-. zl o - .:L;il- d =-'*l (, P -tsUl o e :.:El 3 .: !-ts'6)lo- s \sElu= * i!Ol Q = -'uorl r Y \<o.lu ( at '*l ! X qj t oji - A .:<- -ol - a -!trl a::! =l J : {<zl; .: ltoo -tr €\\ ss% A. * il = {J ,r c Q.<% sv! H.H.\- :i\i rt .x -a\! =s\-% 9- Y qr \! :. tr s'sv='!S !^ u f. S!l9 u sJ\ y l\ F.\', rilfl::) o oI - L l\o 'v! ol -t l6Jrl .z El u ultr !l V ,i ;o.l 0-)ol trqrl ts Ll utl L cl ' Xl d zl< 0) L(n 0.) 'd Lo() .c C t!d -o -o 0) TE '.= tr 0) = oj a .9 .: O ,9 =15 C 0) I Lq) o- .C oa(., E o L 0) -o = = F I (g(JL O() Lo 0)E .= ': o :: tr E oO .9 F OT)C() IL(J o- E o () E .; '; c 'E =o- o o- oF OIoi ;l 'ril ol (gl()l !l .l ol olol o+(El ol -tol -ol -lFI =t zl a o L o{ O 0) L (-) O'J o r) -) F (J d L (J c0 L c) o Eo: (n L bo o .J() 0) (n L 0) oo 03 L o () o^ !^\ o o-dL() F b{ r= ot ol L .o = L1 oltrl o N o I LO "t \ o' qJ Uq t( 0 cl q) z Nqq sUq) bq1 o\ t o t q) '.iqJ 5 ! () 00 .E t- o oL o o0 0)L C) o 6 th trl a U) o o o U, o th L C) (E o .A ott)(n U o.r q)I -ol .(!l ,t-l i otr-E0e oyo1c= SrSt$ !6Igo6 d ==gJoo o(.).9Ca 9qo L,) O- I o- €YL!1 ai ^i.,r o.= O()E E E dGq-;o- o.g -c ., o c c=(g@Oo A =.L,G ,; , .9.2qxvqEe d-: !Y oo H;e :-9o0': d l,o.= !? ilO=-rin-oi:z o o- E >.o -EP o!* oHE O.A>-O-HoaG E!' .N'AgE;8: s oo0r =bO>5 Io a 0) oo * a I I I I I I N o -o Eo o.oa \o c.l O o LA a? =u?a) c)o eo trL .Y! rq.,)9ot A, _O L! I -(dlvEl : dll L-l ol ;41 E 0.,ic0o(i ?1 0) trO 9,a :6 sij rul .-l .ll d)t -ol c€l(-l (.) bJ) F (r>' JO (, o\\o o. -o o\ O \o (-n o\ oM F od. -o o\ \o -o o\$t-- -o o\ v^) o\ oo o. o F \o b!6 o \o $ t-- oo co C. a.) F-N od o't F- \o rn .f 'o ,9 .o 9_q =^7?,o o. oo aa .o' t--(-- OOO $ OOO O aa - d.: ,9-a' -io \o lrai c') aa\o\o o. \oO O\o O \o o o t6Z l-!! 9rPi'..2 L:=*ot G U; t o\F- co -o o\r- \oo\ $ -o o\\o @ D ^ aI) -o -o o\ tr- oo o\ tr- \oo\ o.$ \o co \oGI o bo O ao o bo au O oo (-.l -J ca aa OF- C.l y =.bi9a-, = == u -Jt $s $t ca $ -f, U ps' s'J s$ a-l $t aa <f, -JC. $$ ca c06 ,' = > ". a; 9)e D F aAr o = >, -. -!c+.-!E-aE oaqqa :o c a.) s i- i) '; E E L) N CIoc{ Oc.l o. d. 2,A. Supervipion 2.8.1. Provide altow chart of supervision hierarchy. N P ZONAL N.O.CP IBADAN I STATE ONCHOCERCIASIS CONTROL TEAM (SOCT) I LOCAL GOVERNMENT ONCHOCERCIASIS L I CONTRO TEAM (LOCT) COMMLINITY. CDDS 2.8.2, llhat werp the main issues identified during supervision. The following wdre discovered in the course of supervision: out their (uties. They depended rnostly on the meagre amounts from the Trust Fund for maint{nance and fueling of their motorcl'cles. saw little lnaterial or financial benefits. community level operations had been h'ljacked by the health workers' 2.8.3. ll/as supdrvision checklist used ? Only in very few cases were checklists utilized. 2.8,4. lYhat wete the outcomes at each level of CDTI implementation supervised The following cfnstituted the outcome: support npt only the CDDs but also the distribution. In some cases project staff used their posiiions as supervisors in NIDs to utilize CDDs as guides. Whatever was earned served as a motivation to continue serving as CDD and to cooperate with project personnel. 2'7 wtlO/APOC' l0 APril 2003 discovered. NPI/ M & E officers were invited to training sessions on CDTI so that they can assist in supervision. State officers have requested LGs to appoint non - programme officers as LOCT leaders for they tend to have more time for the programme. 2.8.5. lltas feed-back given to the supervised, and how was the feeclback used in improving the overall performance of the project Whenever and wherever possible communities were inforrned of those areas they are not doing well and are rnobilized to correct the anomalies. Such issues as inadequate CDD compensation have to be brought to the attention of the communities. The LGA health workers were also informed of the findings, and in most cases together with SOCTs try,to find solutions to issues identified. SECTION 3: Support to GDTI 3.{. Financial contributions of the partners and communities Table I l: Financial contributions by all partners for the last three years If there are problents witlt release of counterpurt.funds, how were they acklressecl? Advocacy visits have been and are being paid at both State and LGA levels to ensure continuous release of counterpart funds. Moreover, stakeholders meetings are being planned. Contributor Year I 2000 Year 2 2001 Year 3 2002 TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAL Released (us$) TOTAL Budgeted (us$) TOTAT, Released (us$) Ministry of Health (MOH) 70,000 -5 000 70,000 ,5 00 r0,000 Nil LocalNGDO(s) ( if any) Nit 1 Nil Nit N I I Nit Nit NGDO partner(s) r 9,550 Nil 19,520 NiI Nil District/LGA 21,440 Nil 21.410 r 0200 21,440 4,850 Others a) b) c) Communities APOC Trust Fund r8s,200 129,n0 rs7,s00 I e r::o r07,680 57290 TOTAL 296160 l34,lt0 268,460 t 03,030 139,020 62, I 30 Comments ,9' -v { Wf1O/APOC. 26 September 2003 3.2. Other forms of community support '^ Describe (iy{cale forms of in-kind contributions of communiries tf sny) Some comn'f unities do the following for their CDDs: '/ Qffering of farrn produce.'P Working on their farrns 3.3. Expenditure per activity r Indicate tfre expenditure on activities below in US dollars using the current United Nations exchange rate to local currency Table l2: Inf icate how much the project spent for each activity listed below during the rdponing period Expenditure ($ us) Source(s) of funding HQ area to central collection point of [nd health education of communities DDs falth staff at all levels lDDs and distribution .oring of CDTI activities ts to health and political authorities materials ,nary lreflo.ting) forms for treatment Veh icles/ Motorcycles/ b icycles maintenance Office EquiprJrent (e.g cornputers, printers etc) Travel l IEC l Sum from NOTFDrug deli Activi Training of he Supervising ! Internal monit Advocacy vis{ community Mobilization Training of C l 000 2000 7.750 480 3260 r 500 r 6860 8250 6,850 5000 APOC APOC/MOH APOC APOC APOC APOC APOC/MOH APOC APOC APOC APOC Communicatir I 400 APOC Others 7280 APOC TOTAL 62,130 Total numbe 'of persqns treated 741,596 Comme Qat{-J WHO/APOC, 26 September 2003 SEGTION 4: Sustainability of GDTI 4.1. lnternal; independent participatory monitoring; Evaluation 4,1.1 lltas Monitorittg/evaluation carried out during the reporting period? (tick wttere applicable) Year I Participatory Independent monitoring Mid Term Sustainabi lity Evaluation 5 year Sustainability Evaluation Internal Monitoring by NOTF Other Evaluation by other partners None was carried out within the period of reporting 4.1.2 ll'hat were the recommendations? Not applicable 4.1.3 How have they been implemented? Not applicable 4.2. Gommunity self-monitoring and Stakeholders Meeting Table l3: Community self-monitoring and Stakeholders Meeting (Please acld more rows if necessary) Describe how the results of the community self- nronitoring attd stakeholders meetings halive affected project implementatiott or how they would be utitizecl during the next treatment cycle. District/ LGA Total # of cornmunitiesivillages in the entire project area No of Communities that carried out self rnonitoring (CSM) No of Communities that conducted stakeholders meeting (SHM) TOTAL 3o WIIO/APOC. 26 September 2003 a4.3. sustainability of projects: plan and set targets (mandatory at yr 3) rWhat arrangements have been made to sustain CDTI after APOC funding ceases in terms of: ,4.3.1 Planning at all relevant levels. The evaluation of the State project has been done but the period fell under the 4th year cycle and therefore shall be addressed in the 4th year report. However, within the reporting peiioO the project rvas considering preparation of a 3 - year sustainability plan which will be incorporated into the State health budget. This could not be done until after the evaluation. Meanwhile the project intends to obtain a reliable total population of the endemic communities by 2004; maintain geographic coverage at lOOo , increase therapeutic coverage from the present 74oh to 84% within the next three years. A need assessment will be jconducted for health workers in the 5'h year so that training needs will be identified and appropriately planned for. 4.3.2 Funds At the State level there has been some counterpaft contributions, but these have not been adequate nor regular. With the evaluation of the project the State government has renewed its commitment to funding the CDTI project and encouraging the LGAs to do likewise. Advocacy visits will continue to ensure that LCAs keep on releasing at least minimal amounts for CDTI implementation. The project has also been guaranteed some level of funding from UNICEF till at least 2007. Funding for 2004 is up to, but not exceeding $15,000, and amounts will go down over the next 4 years. By then government contribution is expected to have reached a level that will sustain CDTI operations. 4,3.3 Transport (replacement ond mointenance) As stated in the earlier sections of the report the project expects APOC to replace transport before it finally withdraws funding. This applies also to other capital items which it supplied to the project earlier. At the LGA level the National Primary Health Care Development SBencV which is supported by several international NGDOs occasionally procurespotorcycles for NIDs which are distributed to the LGAs. These are being used for CDTI Activities. At periodic intervals some of the motorcycles are replaced by NPHCDA. With iespect to maintenance some LGAs release minimal amounts for the periodic maintenance of the motorcycles. This, the project knows, will continue. At the State level, some of the funds released by the government have been used in the maintenance of the vehicle and other equiprnent. With more and constant releases this will continue. In the meantime a system of strict control of transport has been put in place. Every trip and every expenditLrre on (fuel, tvres and repair) a log books and monthly conciliation of trip authorization and log bool< entries has been institutionalized. 4.3.4 Other resources This has been partly addressed in the previous section. With regards to IEC materials the project is sensitizing the government on the need to produce some with the withdrawal of APOC funding. 4.3.5 Pleuse provide u wrilten plan with set targets und achievementsfor sofar. 4.3.6 To whut extenl has the plan been implemented 3A WHO/APOC, 26 September 2003 4.4. Integration Outline the extent of integration of CDTI into the PHC structure and the plans for complete integration 4.4.1. Ivermectindeliverymechanisms The Mectizan delivery process occurs within the existing PHC structure. Communities pick their Mectizan requirements from the health facilities, except in few cases where the drug is taken to them. During NIDs, for instance, the LGA/PHC staff who come to picl< up their vaccines also use the opportunity to collect Mectizan. 4.4.2. Training As stated in some parts of the report M & E officers and NPI officers at the LGA level have been trained on CDTI so that they can assist in supervision. 1.4.3. Joint supervision and monitoring witlt other programs At the State level, there are no plans for joint supervision and rnonitoring at present. At the LGA level we are aware that some of the LOCTs are involved in other programmes and occasionally use the opportunity of visits to the community/health facility for one programme to look into other programmes which they are handling. 4.4.4. Release of funds Where there are releases of fund, imprest is released for PHC activities and is controlled by the PHC director. From there minirnal amounts are made available to the Onchocerciasis Coordinator for some routine visits or collection of Mectizan. At both State and LGA levels proposals forthe release of firnds however must pass through the PHC director ancl other normal channels. 4.4.5. Is CDTI included in the PHC budget? At the State level there is a line item for CDTI in the PHC budget. At the LGA level CDTI activities are subsumed under a general PHC budget. 4.4.6. Describe other health progrommes lhol are using the CDTI structure und how this was achieved. Ilthat have been the achievcments? None at the moment. However, during the period being reporled the CDTI structure was used to conduct eye camps during which 75 patients were examined for cataract and 23 persons operatedon. l50personsreceivedfreeeyeglasses.TheprogrammeinitiatedbytheState Onchocerciasis Unit was supported by UNDP. 4,4.7. Describe others issues cortsidered in the integratiot, of CDTL a 3e, \.\'HO/APOC. 26 September 2003 aa 4.5 Operational research 4.5.1 Summarize in not more lhan one half of o poge the operational research undertaken in the project areo within the reporting period. None was undertaken during the reporting period 4.5.2. How were the results applied in the project? SEGTION 5: Strengths, weaknesses and challenges List the strengths and weoknesses of CDTI implementation process Strengths * Most communities are fulfilling their roles under GDTI as seen in table 3.{' In some communities where village Health committees have not been non-existent, these ' have been constituted and made functional in the course of implementation CDTL * Usage of CDTI structures for the d istribution of I 50 eye glasses and removal of cataracts in 23 patients. lWeaknesses * Lacks of adequate commitment of LGA Coordinators particularly in return rendition, supply of vital and urgent information as demanded by the NOTF secretariat, * Few communities are giving incentives to their CDDs. + Lack of updated census population figures to measure correctly treatment coverage rates. I Lisl the challenges and indicate how they were uddressed. The project implementation was constrained by:- I i:. 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